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Blood, 15 August 2007, Vol. 110, No. 4, pp. 1353-1358.
Prepublished online as a Blood First Edition Paper on May 7, 2007; DOI 10.1182/blood-2007-02-072520.
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RED CELLS
The human counterpart of zebrafish shiraz shows sideroblastic-like microcytic anemia and iron overload
Clara Camaschella1,2,
Alessandro Campanella1,
Luigia De Falco4,
Loredana Boschetto4,
Roberta Merlini5,
Laura Silvestri2,
Sonia Levi1,2, and
Achille Iolascon3,4
1 Vita-Salute University and
2 Instituto di Ricerca e Cura a Carattere Scientifico (IRCCS) San Raffaele, Milan;
3 Department of Biochemistry and Medical Biotechnologies, University Federico II, Naples;
4 Centre of Genetics Engineering (CEINGE) Advanced Biotechnologies, Naples;
5 Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
Inherited microcytic-hypochromic anemias in rodents and zebrafish suggest the existence of corresponding human disorders. The zebrafish mutant shiraz has severe anemia and is embryonically lethal because of glutaredoxin 5 (GRLX5) deletion, insufficient biogenesis of mitochondrial iron-sulfur (Fe/S) clusters, and deregulated iron-regulatory protein 1 (IRP1) activity. This leads to stabilization of transferrin receptor 1 (TfR) RNA, repression of ferritin, and ALA-synthase 2 (ALAS2) translation with impaired heme synthesis. We report the first case of GLRX5 deficiency in a middle-aged anemic male with iron overload and a low number of ringed sideroblasts. Anemia was worsened by blood transfusions but partially reversed by iron chelation. The patient had a homozygous (c.294A>G) mutation that interferes with intron 1 splicing and drastically reduces GLRX5 RNA. As in shiraz, aconitase and H-ferritin levels were low and TfR level was high in the patient's cells, compatible with increased IRP1 binding. Based on the biochemical and clinical phenotype, we hypothesize that IRP2, less degraded by low heme, contributes to the repression of the erythroblasts ferritin and ALAS2, increasing mitochondrial iron. Iron chelation, redistributing iron to the cytosol, might relieve IRP2 excess, improving heme synthesis and anemia. GLRX5 function is highly conserved, but at variance with zebrafish, its defect in humans leads to anemia and iron overload.

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